Warning Signs
Some of the points listed below may help you identify a potential problem.

Excessive concerns about weight.
Strict dietary restraints (eating "healthy" or "safe" foods only).
Regularly skip meals and give excuses for not eating with family
and friends.
Intense fear of gaining weight or being fat.
Distorted perceptions of body weight or size.
Continuous weight loss or dramatic fluctuations in weight.
Guilt or shame about eating.
Secretive binges and vomiting.
Frequent visits to bathroom during meals or immediately after meals.
Compulsive exercising or strict exercise routine.
Irregular menstrual cycles or cessation of menstruation altogether.
Social withdrawal.
Irritable, tearful, and depressed with occasional angry outbursts
and mood swings.
Difficulty concentrating. Increased time spent on studies or work.
Fatigue, fainting or dizzy spells.

Note: The presence of one or more of these signs is not necessarily
evidence of an eating disorder.

What is Anorexia?
Anorexia nervosa is an eating disorder characterised by severe weight loss due to
self-starvation. Anorexia is probably caused by a combination of social pressures,
personal factors, and biological vulnerability. Underlying
causes will differ between individuals.

Physical Characteristics:

Marked weight loss as a result of deliberate starvation or a rigid diet.
Loss or thinning of hair.
Skin and nail problems.
Sensitivity to cold.
In females; loss of periods (amenorrhoea). in pre-pubescent girls,
periods may never start.
Growth of fine body hair (lanugo).
Constipation.
Insomnia.
Behavioural Characteristics:

Unusual eating habits / unusual food rituals such as cutting food into tiny pieces.
Arranging food in a certain manner before eating, spending long periods of time eating
meals.
Eating only a particular textured or coloured food.
Others are known to hoard food, steal food or throw away food. also, sufferers are known
to regularly make excuses for not eating food.
Excessive exercise or hyperactivity in an attempt to lose more weight.
Frequent weighing of body weight.
Increasing withdrawal from social activities.
Psychological Characteristics:

Low self-esteem; individuals with an eating disorder frequently have low self-worth and a
strong sense of ineffectiveness.
Depression. Many experience depression ans some will voice suicide ideation.
Perfectionism, perfectionist ideals - expecting excellence in everything.
Intense fear of becoming fat and this fear does not decrease with weight loss.
Distorted body image and claim to feel fat even though emaciated.
Constant pre-occupation with thoughts of food.
Note:
All symptoms may not necessarily be evident simultaneosly
and presentation of one or more of these symptoms does not
necessarily lead to anorexia nervosa. The aggregate mortality
associated with anorexia is 12 times higher than the annual death
rate due to all causes of death for females (in the general population)
aged 15-24 years.

What is Bulimia?
Bulimia nervosa is an eating disorder characterisedby uncontrollable consumption of food
(binging) followed by purging behaviour. Bulimia has severe medical consequences.

Physical Characteristics:

Near average weight or slightly over or underweight.
Dramatic weight fluctuations brought about by frequent binge-eating and purging.
Swollen salivary glands (puffy cheeks) and chronic hoarseness. forced vomiting can cause
blistering, tearing and bleeding of the throat and oesophagus.
Dental decay from stomach acid (erosion of the enamel layer, dental cavaties).
Disturbance of the menstrual cycle.
Hair, nail and skin problems.
Constipation (laxative, diuretics and emetics may contribute).
Purging may take the form of fasting or excessive exercise.
Behavioural Characteristics:

Strong urges to bing-purge.
Abuse of laxatives, diuretics, diet pills or emetics in an attempt to achieve weight loss.
Secretive behaviour (hiding binge-purge behaviours due to shame).
Social withdrawal (isolation, spending more time on food related activities).
Psychological Characteristics:

Low self-steem, poor self-image.
An overwhelming fear of becoming fat with great importance attached to being slender.
Constant pre-occupation with food.
Feelings of guilt, shame and self-loathing.
Depression and at times, suicidal thoughts.
Mood swings and increased irritability.

Note: All symptoms may not necessarily be evident simultaneosly
and presentation of one or more of these symptoms does not
necessarily lead to bulimia nervosa.

How are Families and Friends Affected?

Although the anorexia nervosa or bulimia
nervosa symptoms are only experienced by one person, the effects of these eating disorders
go far beyond the sufferers own lives. Relatives and friends are often drawn into a
painful downward spiral, some more than others. Many relatives and friends who know of a
loved one with an eating disorder often struggle with a range of emotions:

Anger. One of the main emotions that carers experience is anger.
The anger can be directed at the person with the eating disorder. It could be directed at
themselves for their inability to fix the problem. At times, they may even feel angry with
the doctors for not helping the individual to recover earlier.

Distress. Relatives and friends often experience a deep concern
for the person with the eating disorder as they watch her/him go down a road of self-
destruction. They also feel distressed for not knowing how to help.

Guilt. Many carers also experience guilt, wondering what they
have done to contribute to the problem. The guilt is further accentuated when well meaning
friends and neighbours begin to imply that they must have done something wrong to bring
this eating disorder about.

Fear. There is also fear of losing the sufferer altogether, as
the disorder takes over more and more of the persons life.

Mistrust. Of all of the above, mistrust is the most damaging
effect the disorder has on relationships, as relatives and friends begin to lose their
trust in the sufferer. The person with an eating disorder has lied repeatedly to cover up
her habit. So, relatives and friends feel compelled to spy or catch her/him red-handed or
trying to out-smart the her/him.

Survival suggestions for families.

Don't Panic
Look around for the help you need.
Dont isolate yourself from those who can help, or whom you may be able to help.
Dont assume the person knows what they need or how you can help.
Dont make your love a condition of the individuals appearance, health, weight,
achievement, or any other attribute.
Dont comment - positively or negatively - on appearance or weight.
Dont let these peculiarities dominate the household.
Dont be manipulated - require your relative to be responsible for his or her
behaviour.
Dont force or encourage your relative to eat or drink properly.
Dont try to control your relatives behaviour - this can intensify the problem.
Dont impose rules except those which are necessary for the individuals or the
familys safety and well-being, and avoid power struggles.
Dont feel guilty or dwell on causes.
Dont expect yourself to be a perfect parent.
Dont expect (or hope) your relative to be perfect.
Dont expect that the amount of time you worry will help somehow. See to proper
treatment, then relax yourself. Do realise there is no quick and easy solution.
Do inform yourself about the disorders and their treatment.
Do attend support groups. They are there for you.
Do encourage your relative to get a professional assessment, from a practitioner
experienced in eating disorders.
Do express honest love, by physical and verbal expression.
Do value that your relative is ambivalent about getting well, and takes comfort in the
control and rituals of the disorder.
Do examine your feelings and thoughts about anorexia and bulimia, and your own body image
or fear of fat issues.
Do encourage decision making and being responsible for those decisions.
Do allow your relative to be in charge of his or her routines of daily life.
Do realise that by giving up control, youre setting the stage for your relative to
develop health self-control.
Do seek life saving treatment for anyone who is in jeopardy of endangering themselves or
others.
Do accept yourself.
Do accept your relative.
Do make time for yourself, spouse, friends, other family members - remember to provide for
yourself with rest, freedom from worry, and fun.
Do get help for yourself. The disorder disrupts the family to and the family needs help
coping with it.
Do remember to do fun things with your friend/relative.